The effects of prenatal exposure to undernutrition on glucose and insulin metabolism in later life

Purpose of reviewEvidence from experimental and epidemiologic studies suggests that early nutrition may play an important role in the pathogenesis of type 2 diabetes. It is hypothesized that the fetus adapts its structure and physiology in response to an adverse environment in utero, which predisposes to chronic disease in later life. We review results from the Dutch famine birth cohort study, in which the effects of prenatal exposure to famine on health in later life are investigated. We focus on the consequences for glucose and insulin metabolism. Recent findingsPeople exposed to famine during gestation show impaired glucose tolerance at ages 50 and 58 years. The aetiology of this association seems to lie, at least partly, in programming of the pancreatic beta cell, resulting in an impaired insulin response that is already present in the normoglycaemic state. We found no evidence indicating that the hypothalamic–pituitary–adrenal axis plays an intermediate role in the association between prenatal undernutrition and glucose intolerance. SummaryAlthough the exact pathophysiology of the association between exposure to famine in utero and glucose intolerance is not clear, our findings stress the importance of maternal nutrition during gestation for the offspring's glucose metabolism in later life.